Provider Demographics
NPI:1992754881
Name:HOFF, GWEN (LMSW)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:HOFF
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W IONIA ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-5136
Mailing Address - Country:US
Mailing Address - Phone:989-493-0551
Mailing Address - Fax:989-894-0068
Practice Address - Street 1:721 WASHINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5729
Practice Address - Country:US
Practice Address - Phone:989-225-9185
Practice Address - Fax:989-894-0068
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801013287104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG96288005Medicare PIN